Regulatory Performance Analyst

Dale Workforce Solutions

Phila, PA

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JOB DETAILS

SKILLS

Analysis Skills, Billing, Citrix Product Family, Communication Skills, Corrective Action, Documentation, Federal Laws and Regulations, Health Insurance, Insurance Regulations, Interpret Regulations, Legal, Legal Research, Maintain Compliance, Managed Care, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Organizational Skills, Performance Analysis, Presentation/Verbal Skills, Problem Solving Skills, Regulations, Regulatory Compliance, Regulatory Requirements, Risk Management, Root Cause Analysis, State Laws and Regulations, Trend Analysis, Writing Skills

LOCATION

Phila, PA

POSTED

2 days ago

Client: Health Insurance
Title: Regulatory Compliance Analyst

Summary:
As a Regulatory Compliance Analyst, you will identify, document, and track the resolution of compliance issues in operational performance areas (e.g. billing, enrollment, claims) of a major health insurance issuer. You will also research state and federal laws relating to the Affordable Care Act, providing key insights to guide our operations.

We are looking for a highly independent professional with a knack for research, analysis, and adaptive problem solving. A legal background is a significant plus for success in this position.

Key Responsibilities:

Regulatory Analysis: Interpret and analyze federal and state regulatory requirements, providing clear regulatory guidance to operational teams and ensuring effective implementation of new laws and regulations.
Corrective Action Plan (CAP) Tracking: Leverage compliance tracking software to document CAPs and develop remediation plans, ensuring alignment with regulatory standards. Maintain regular updates on disclosed issues.
Operational Collaboration: Work closely with business areas to address compliance gaps, ensuring that they are taking appropriate ownership of any CAPs under their purview, thoroughly analyzing root cause, providing evidence remediation, and documenting updated processes in policies and procedures.
Proactive Monitoring: Analyze indicators, identify trends, and monitor potential compliance risks, escalating issues and driving resolution as needed.

Qualifications:

Education & Experience: Bachelor’s degree or equivalent work experience, with a minimum of 3 years in managed care, health care, or related field.
Preferred Background: Experience in compliance and familiarity with health insurance operations and regulations (especially the Affordable Care Act). A JD or legal research experience are both highly advantageous.
Skills: Exceptional organizational, verbal, and written communication skills; proficiency in Microsoft Office (especially Outlook, Teams, Word, Excel); familiarity with Citrix; adaptability to new technology, and the ability to work independently in a fast-paced environment are all musts.

About the Company

Dale Workforce Solutions

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